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  • Parent/ Guardian Declaration Form: Page 1 of 1

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    abdullah
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    This parent/guardian declaration form is for reporting a student's COVID-19 rapid antigen test results before attending school. It requires the student and parent/guardian's names and contact information, the school details, test date and time, and test results (negative, positive, or defective). The parent/guardian must acknowledge the accuracy of the information and that the test was conducted properly. Their signature is also required, along with the date, to verify the test results reported for the student.

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    Original Title

    نموذج تعهد ولي الأمر

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    This parent/guardian declaration form is for reporting a student's COVID-19 rapid antigen test results before attending school. It requires the student and parent/guardian's names and contact information, the school details, test date and time, and test results (negative, positive, or defective). The parent/guardian must acknowledge the accuracy of the information and that the test was conducted properly. Their signature is also required, along with the date, to verify the test results reported for the student.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as pdf or txt
    37 views1 page

    Parent/ Guardian Declaration Form: Page 1 of 1

    Uploaded by

    abdullah
    This parent/guardian declaration form is for reporting a student's COVID-19 rapid antigen test results before attending school. It requires the student and parent/guardian's names and contact information, the school details, test date and time, and test results (negative, positive, or defective). The parent/guardian must acknowledge the accuracy of the information and that the test was conducted properly. Their signature is also required, along with the date, to verify the test results reported for the student.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as pdf or txt
    of 1

    Parent/ Guardian Declaration Form

    Student Name …………………………………. QID ………………………………….

    School Name …………………………………. Class/ Division ……………… /…………………

    Examination time Day …………………………………. Date (day-month) ……/……/2022

    Test Result

    Negative Positive

    Acknowledgement: I hereby acknowledge that the information submitted in this declaration form are
    accurate and complete. The Rapid Antigen Test has been conducted as per the procedures and instructions of
    the Ministry of Public Health.

    Parent/ Guardian Name …………………………………. Relationship to student ………………………………….

    Date (day-month) ……/…… /2022 Parent/ Guardian Signature ………………………………….


    Important Notes about Test Results
    Negative The student shall attend school and MUST present the parent /guardian declaration form.
    The student shall NOT attend school and must visit the nearest Health Center and follow
    Positive the procedures of the Ministry of Public Health.

    Defective Result The student shall NOT attend school and must visit the nearest Health Center and follow
    the procedures of the Ministry of Public Health.

    Page 1 of 1

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